Abstract:
OBJECTIVES:To study the care pathway effect on the percentage of patients with ST-elevation myocardial infarction -(STEMI) receiving timely coronary reperfusion and the percentage of STEMI patients receiving optimal secondary prevention. METHODS:A care pathway was implemented by the Collaborative Model for Achieving Breakthrough Improvement. One pre-intervention and 2 post-intervention audits included all adult STEMI patients admitted within 24 h after onset and eligible for reperfusion. Adjusted (hospital random intercepts and controls for transfer and out-of-office admission) differences in composite outcomes were analyzed by a multilevel logistic regression. RESULTS:Significant improvements in intervals between the first medical contact (FMC) to percutaneous coronary intervention (PCI) and between the door to PCI were shown between post-intervention audit II and post-intervention audit I. Secondary prevention significantly deteriorated at post-intervention audit I but improved significantly between both post-intervention audits. Six out of nine outcomes were significantly poorer in the case of transfer. The interval from FMC to PCI was significantly poorer for patients admitted during out-of-office hours. CONCLUSIONS:After care pathway implementation, composite outcomes improved for in-hospital STEMI care. Collaborative efforts exploited heterogeneity in performance between hospitals. Iterative and incremental care pathway implementation maximized performance improvement.
journal_name
Cardiologyjournal_title
Cardiologyauthors
Aeyels D,Bruyneel L,Sinnaeve PR,Claeys MJ,Gevaert S,Schoors D,Panella M,Sermeus W,Vanhaecht Kdoi
10.1159/000488932subject
Has Abstractpub_date
2018-01-01 00:00:00pages
163-174issue
3eissn
0008-6312issn
1421-9751pii
000488932journal_volume
140pub_type
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